Discussion

LIMITATIONS
This evaluation has several limitations. One limitation is the inability to weight the importance of different outcomes of the projects. For instance, if a team received a score of three for dissemination to the scientific community, and also received a score of three for dissemination to the targeted community, it is a value judgment to decide that those two forms of dissemination should be weighted equally. Perhaps community presentations should be weighted more greatly than scientific presentations in collaborative research.

Another limitation is that this evaluation focuses primarily on participants' perceptions, experiences, and views, and not on any external measures or validation. Finally, the evaluator did not consider whether the results of the research were important or statistically significant. Results that are not considered to be important in the field of breast cancer research or statistically significant can be expected to have fewer outcomes and little impact.

The limited number of projects (seven) included in this study and the qualitative research methods used limit the ability to generalize the results to other projects.

IMPLICATIONS
This evaluation provides evidence that the Community Research Collaboration Awards add significant value to the California Breast Cancer Research Program (CBCRP) research portfolio in many ways.

The majority of research we fund on populations under-represented in breast cancer research is funded through CRC Awards. Given the diversity of California, it is Discussion 26 particularly critical for the CBCRP to stimulate research with these populations, and the CRC Program provides us an opportunity to do so.

In the past, research addressing underserved communities has often left community members feeling exploited by researchers who come in from outside and conduct research that leaves the community no lasting benefit. In contrast, the CRC Awards empowered communities to address questions that were important to them. The projects conducted through the CRC Program have brought significant benefit to the concerned communities and to individual community members. These projects have also had tangible impacts on community programs, policies and program funding. These results, and the collaborative methods used in the projects, have resulted in increased trust and appreciation of research in these communities. This may well increase trust and enthusiasm for research within these populations, thus stimulating further research.

The research methodology and results were improved through the collaborative process. Research conducted with funding from the CRC Awards had excellent recruitment and retention of subjects and developed culturally sensitive and community-tailored research methods. Interpretation of research results and dissemination of the results, especially to the general public and to policy-makers, were enhanced by the collaborative process. This allowed the research to move quickly to application in the real world.

This combination of findings strongly suggests that the CRC program may be the most appropriate and effective way to perform breast cancer research within California's diverse populations. The CRC Program provides the framework for more rigorous and relevant research within communities. This research empowers and benefits these communities and results in rapid translation and dissemination.

The projects studied in this evaluation did not consistently achieve all the outcomes expected of Community-based Participatory Research.. The significant variation in outcomes between projects and reasons for this variation should be more thoroughly explored. Since the outcomes were predicted based on the theory and practice of Community-based Participatory Research, and there is evidence from this evaluation that how Community-based Participatory Research was practiced by the CRC research teams varied, it is possible that variations in collaboration may explain all or part of the variation in outcomes. The lower impact of CRC research on analysis of data and publication of scientific articles are areas that should be further explored. Understanding the reasons for some teams not achieving these outcomes may allow for interventions that can increase these outcomes for future CRC teams. The CBCRP may be able to facilitate success in CRC Awards by providing education and technical assistance to teams, monitoring the practice of Community-based Participatory Research principles, and intervening as necessary.

The reasons that the CRC projects studied here did not achieve other outcomes expected of Community-based Participatory Research may be more heavily influenced by the external environment. CRC researchers receiving honors, awards, or funding to conduct additional research depends upon the extent to which Communitybased Participatory Research is valued by others. Community-based Participatory Research is not yet universally recognized as scientifically rigorous or valuable to communities or academia. In the past five years, however, financial and other support for Community-based Participatory Research has increased. We hope this evaluation contributes to a better understanding of the benefits of supporting Community-based Participatory Research. It may be that an evaluation five to ten years from now would be much stronger in outcomes that depend on external recognition of the value of this type of research.

Finally, continued evaluation of our CRC Awards will allow the exploration of these and other questions, and increase the size of the sample as new projects are awarded annually.